Smoking, drinking, exercise and diet: awkward to talk about

The communication skills of general practitioners and practice nurses are good in general. Yet in spite of this, discussions with patients about lifestyle could be better. Research by Janneke Noordman from the Netherlands Institute for Health Services Research (NIVEL) has shown that motivational interviewing is hardly used at all. Noordman was awarded her PhD from Radboud University Nijmegen on 31 May, 2013.

Janneke Noordman studied how communication relating to lifestyle is carried out in general practice. She studied videos of everyday consultations that had taken place between 1975 and 2011 to see how the topics of smoking, drinking, physical exercise and diet were approached. During these years, the focus in medicine moved gradually towards prevention and this was also reflected in general practice. Talking about topics such as smoking, diet and physical exercise has become more commonplace over the years, although the number of discussions on drinking alcohol has remained more or less the same. Nevertheless, general practitioners apparently focus on giving general information and advice to their patients.
Training in motivational interviewing
Nowadays, in many general practices, discussing lifestyle behaviour with patients is a task for the practice nurse. For this purpose, practice nurses are given training in motivational interviewing techniques where they learn how to show empathy, ask open questions, acknowledge statements, listen carefully and summarize what the patient says. But in spite of the training, the application of motivational interviewing techniques in practice is not routine. Practice nurses ought to be using the techniques more, for instance before patients are noticing the health benefits they could have from e.g. stopping smoking or doing more physical exercise. This often only takes place when patients themselves have shown a willingness to change their behaviour. However, as a topic, the lifestyle of patients does come up regularly in consultations with practice nurses and they are giving tailored advice more often.

Video feedback
Noordman also looked at ways of improving the training. Video feedback appeared to be effective in improving the communication skills of practice nurses. After just one session they paid more attention to the patient’s care request, provided more explanation of medical tests and gave patients more understandable information. Furthermore, they applied more of the motivational interviewing skill elements. Janneke Noordman explains: “Whether or not this will take root in the long run and lead to better health outcomes in patients remains to be seen. But the short term result with regard to communication was striking – and that is very promising.”
Ministry of Health, Welfare and Sport
Ministry of Education, Culture and Science